Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 8-181, Baltimore, MD 21287, USA.
Neurosurg Clin N Am. 2010 Apr;21(2):247-61. doi: 10.1016/j.nec.2009.10.003.
Aneurysmal subarachnoid hemorrhage (aSAH) is a common and often devastating condition that requires prompt neurosurgical evaluation and intervention. Modern management of aSAH involves a multidisciplinary team of subspecialists, including vascular neurosurgeons, neurocritical care specialists and, frequently, neurointerventional radiologists. This team is responsible for stabilizing the patient on presentation, diagnosing the offending ruptured aneurysm, securing the aneurysm, and managing the patient through a typically prolonged and complicated hospital course. Surgical intervention has remained a definitive treatment for ruptured cerebral aneurysms since the early 1900s. Over the subsequent decades, many innovations in microsurgical technique, adjuvant maneuvers, and intraoperative and perioperative medical therapies have advanced the care of patients with aSAH. This report focuses on the modern surgical management of patients with aSAH. Following a brief historical perspective on the origin of aneurysm surgery, the topics discussed include the timing of surgical intervention after aSAH, commonly used surgical approaches and craniotomies, fenestration of the lamina terminalis, intraoperative neurophysiological monitoring, intraoperative digital subtraction and fluorescent angiography, temporary clipping, deep hypothermic cardiopulmonary bypass, management of acute hydrocephalus, cerebral revascularization, and novel clip configurations and microsurgical techniques. Many of the topics highlighted in this report represent some of the more debated techniques in vascular neurosurgery. The popularity of such techniques is constantly evolving as new studies are performed and data about their utility become available.
颅内动脉瘤性蛛网膜下腔出血（aSAH）是一种常见且常具破坏性的疾病，需要神经外科迅速评估和干预。aSAH 的现代治疗涉及血管神经外科医生、神经重症专家和神经介入放射学家等多学科专业人员组成的团队。该团队负责在患者就诊时稳定病情，诊断破裂的出血性动脉瘤，夹闭动脉瘤，并管理患者经历典型的长期和复杂的住院过程。自 20 世纪初以来，手术干预一直是破裂脑动脉瘤的明确治疗方法。在随后的几十年中，显微外科技术、辅助操作以及术中及围手术期药物治疗方面的许多创新，推动了 aSAH 患者的治疗进展。本报告重点介绍 aSAH 患者的现代手术治疗。简要回顾动脉瘤手术的起源后，将讨论以下主题：aSAH 后手术干预的时机、常用的手术入路和开颅术、终板开窗术、术中神经生理监测、术中数字减影和荧光血管造影、临时夹闭、深低温心肺旁路、急性脑积水的处理、脑血运重建以及新型夹闭装置和显微外科技术。本报告中强调的许多主题代表了血管神经外科中一些更具争议性的技术。随着新研究的开展以及有关其效用的数据的出现，这些技术的普及程度不断变化。
